Challenges of measuring and linking patient outcomes to nursing interventions in acute care settings

Measuring and linking patient outcomes to nursing intervention is an important task that has professional, financial and political ramifications. The importance and complexity of measuring patient outcomes accurately should not be overlooked, as there are a number of emergent factors that influence this process. These include the turbulent context of practise, variations in care due to the large number of health professionals, individual patient characteristics impacting on outcomes, determining appropriate nursing outcome measures, nursing's lack of autonomy within the system and difficulties experienced while trying to link patient outcomes to nursing interventions. So that the results reflect reality, it is important for researchers in the field to take note and consider these factors when measuring patient outcomes. The present article aimed to examine and discuss a number of these factors as they relate to the evaluation of patient care.

The quest for single-enantiomer outcomes in free-radical chemistry

A significant challenge facing free-radical chemists is in the area of stereocontrol, specifically the ability to control the direction of reagent attack at a prochiral radical. While significant inroads have been made in the area of diastereoselective radical chemistry, less successful have been attempts to provide truly enantioselective processes. This article highlights recent efforts in the area of enantioselective free-radical reduction chemistry and describes how single-enantiomer outcomes are possible when simple enantiopure stannanes are used in conjunction with large, sterically-demanding Lewis acids. Selectivities in excess of 90% are now possible, with one example in excess of 99.5% ee provided.

Outcomes, standards and benchmarks

The use of outcomes as a tool for curriculum development has considerable currency in Australia. It is widely perceived as representing world's best practice (South Australia Department of Education, Training and Employment, 2000, foreword) and as providing an effective means for quality assurance and enhancement (Willis & Kissane, 1997). At a system level, these assumptions have been unquestioned and unexamined, and curriculum frameworks in all Australian States now consider themselves to be 'outcome-based'. Surprisingly, this results in little similarity between Australian State educational frameworks, and raises the question of what I really understood about the concept of an 'outcome'. This essay explores some definitions of the term and related concepts of 'standards' and 'benchmarks'. The latter terms have less currency in Australia but can be shown to more accurately describe much of what we consider to be outcomes. The issue is not a semantic one, but goes to the very heart of our intentions in specifying learning outcomes. The indiscriminate use of the term 'outcome' has largely devalued it to the point that there is little real understanding and little debate about the efficacy of outcome setting as the primary process in curriculum production in Australia.

Bystander resuscitation attempts at heroin overdose: does it improve outcomes?

Study objective: To document the characteristics and effectiveness of cardiopulmonary resuscitation (CPR) at non-fatal heroin overdose events in Melbourne, Australia. Methods: A retrospective analysis of a computerised database of ambulance attendance records at non-fatal heroin overdose cases for the period 1/12/1998 to 31/7/2000 was undertaken.

Main outcome measures: The main outcome measure was the rate of patient hospitalisation. The rate of CPR administration at heroin overdose cases was also examined, along with characteristics of the attendance, such as the age and sex of the overdose case, the relationship of person providing CPR to the overdose case as well as the location, time and date of the event.

Results: CPR was administered prior to ambulance arrival in 579 heroin overdose cases (9.4% of total heroin overdose cases attended) between 1/12/98 and 31/7/2000. A greater proportion of female overdose cases were administered CPR than males and CPR administrations were evenly distributed across attendances occurring in private and public locations. Bystander administration of CPR prior to ambulance attendance resulted in a significantly lower rate of heroin user hospitalisation (14.5%) compared to cases where bystander CPR was not administered (18.8%).

Conclusions: While CPR administration prior to ambulance attendance at heroin overdose events is relatively uncommon (especially compared to out-of-hospital cardiac arrest), such administration was associated with a statistically significant improvement in clinical outcomes in cases of non-fatal heroin overdose. These findings suggest that the provision of CPR training to people likely to come into contact with heroin overdose events may be an effective strategy at minimising consequent overdose-related harm.

Teachers reactions to outcomes-based music education in South African primary schools

This article examines the reactions of specialist music teachers to the introduction of Outcomes-Based Education (OBE) in South Africa. OBE has been seen in post-apartheid South Africa as a way to transform education and address the imbalances of the past. The study reported here used questionnaires to explore attitudes of teachers at independent schools in Johannesburg in the first year of implementing OBE. Analysis of data revealed both positive and negative attitudes as well as the strong need for teachers professional development if OBE is to succeed.

The medical provision of hydration and nutrition: Two very different outcomes in Victoria and Florida

Decisions to withhold or withdraw medical hydration and nutrition are amongst the most difficult that confront patients and their families, medical
and other health professionals all over the world. This article discusses two cases relating to lawful withdrawal and withholding of a percutaneous endoscopic gastrostomy tube (PEG) from incompetent patients with no hope of recovery. Victoria and Florida have statutory frameworks that provide for advance directives, however in both Gardner; Re BWV and Schindler v Schiavo; Re Scliiavo the respective patients did not leave documented instructions. The article analyses the two cases and their outcomes from legal, medical and ethical perspectives.

Perceptions of the learning context and learning approaches : implications for quality learning outcomes in accounting

This study analyses learning approaches, course perceptions and learning outcomes of a group of second year accounting students at an Australian university using qualitative data analysis techniques. The research method involves the development of a series of matrices linking types of motives and strategies used by students in their study, together with their perceptions of the learning context associated with learning outcomes. The study focuses on assessing the links between learning approaches and a qualitative assessment of students' conceptual understanding of aspects of financial accounting studied at the undergraduate level. The results confirm how individual differences in the perceptions of the learning context relate to study motives and strategies. The findings show how different forms of memorisation relate to study strategies and how the completion of accounting tasks link to students' perceptions of course requirements. There was also some evidence that, in terms of learning outcomes, students with sophisticated levels of understanding of concepts, tended to have consistent deep and achieving approaches to learning. This result was compared with students' academic performance as a measure of learning outcome. Discrepancies between these two measures of learning outcome are highlighted in the conclusions. The findings strengthen the case for further investigation of the use of measures other than academic performance in examining relationships between learning approaches and learning outcomes.

Which work characteristics predict employee outcomes for the public-sector employee? An examination of generic and occupation-specific characteristics

The wide-ranging changes that have occurred in the public sector over recent years have placed increasing demands on public-sector employees. A survey of employees within a relatively commercially-oriented public-sector organization in Australia was used to test a demand-oriented generic model of employee well-being and a variety of situation-specific variables. The presence of support at work and the amount of control an employee had over their job were found to be key predictors of employee-level outcomes. Perceptions of pay and the perception of a lack of human resources (HR) were also found to predict employee outcome variables. The results emphasize the impact that middle managers and HR managers can have in terms of reducing the detrimental employee effects that can be caused by the introduction of new public management (NPM) and the potential for a positive impact on employees. In particular, public-sector managers can use the design of jobs and the development of social support mechanisms, such as employee assistance programmes, to maintain, if not improve, the quality of working life experienced by their employees. More broadly, this study has found that the job strain model is a useful tool in a public-sector environment and is likely to be of increasing utility with the continuing introduction or consolidation of NPM over time. Managing these issues in the new public sector could be a key means of protecting the key resource of the Australian public sector - the employees.

Improving child and family outcomes following complicated births requiring admission to neonatal intensive care units

This paper reviews current research regarding the impact of birth complications, such as preterm labour, on parents and the nuclear family system. Specifically, how parents cope with the neonatal intensive care unit (NICU) experience and the associated decision-making tasks required during complicated births will be investigated. Consequences of poor adaptation to prematurity for the parent, family and infant relationships will also be discussed. The importance of informed decision-making, perceived control, self-esteem and the benefits of certain strategies, such as kangaroo care (skin-to-skin contact), in the facilitation of greater levels of attachment and improved relationships, will be highlighted. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Will it work? an initial examination of the processes and outcomes of converting course materials to CD-ROMs

The Faculty of Business and Law at Deakin University (Victoria, Australia) decided to dispense of all printed post-graduate learning materials and replace them with CD-ROMs from the commencement of the 2006 academic year. In addition, CD-ROMs were developed for a limited
number of undergraduate units as part of a future delivery plan for this cohort of students. The following paper describes this project, the reasons underpinning it, and the processes the Faculty adopted to implement the project. The project is ongoing and part of a broader agenda for change
that will see an even greater application of electronic technology to teaching and learning within the Faculty. Although only initial findings and observations are possible at this stage, the project provides a basis for longitudinal reporting and, potentially, a guide for other institutions who may
be considering such a move. The paper reports on these observations and on those in the educational development arena and suggests that the Faculty will need to learn from these initial experiences and evaluate the project in greater depth to guarantee a smooth transition for all stakeholders.

Organizational change in the public sector: augmenting the demand control model to predict employee outcomes under New Public Management

This study identifies the environmental and personal characteristics that predict employee outcomes within an Australian public sector organization that had, under New Public Management (NPM), implemented a variety of practices traditionally found in the private sector. These are more results-oriented, and their adoption can be accompanied by increased strain for employees. The current investigation was guided by two complementary theories, the Demand Control Support (DCS) model and Conservation of Resources (COR) theory, and sought to examine the benefits of building on the DCS to include both situation-specific stressors and internal coping resources. Survey responses from 1,155 employees were analysed. The hierarchical regression analyses indicated that both external and employee-centred variables made significant contributions to variations in psychological health, job satisfaction, and organizational commitment. The external resources, work based support and, to a lesser extent, job control, predicted relatively large proportions of the variance in the target variables. The situation-specific stressors, particularly those involving harmful management practices (e.g., insufficient time to do job as well as you would like, lack of recognition for good work), made significant contributions to the outcome measures and generally supported the process of augmenting the generic components of the DCS with more situation-specific variables. In terms of internal resources, problem and emotion-based coping improved the capacity of the model to predict psychological health. The results suggest that the impact of NPM can be ameliorated by incorporating the dimensions of the augmented DCS and coping resources into the change programme.

Work characteristics and employee outcomes in local government

The overall objective of this study was to examine the work characteristics that make significant contributions to extra-role performance (as measured by the helping dimension of citizenship behaviour) and employee wellbeing (measured by job satisfaction and psychological health) in a local government. The work characteristics examined were based on the demand-control-support (DCS) model, augmented by organization-specific characteristics. The results indicate that characteristics described in the core DCS are just as relevant to extra-role performance as they are to more traditional indicators of job stress. Although the more situation-specific conditions were not predictive of citizenship behaviour, they made unique contributions to job satisfaction

Paediatric quality of life instruments: a review of the impact of the conceptual framework on outcomes

With an increasing number of paediatric quality of life (QOL) instruments being developed, it is becoming difficult for researchers and clinicians to select the most appropriate instrument. Reviews of QOL instruments tend to report only basic properties of the instruments such as domains and psychometric properties. This paper seeks to appraise critically the conceptual underpinnings of paediatric QOL instruments. A systematic review was conducted to identify QOL instruments for children aged 0 to 12 years, and to examine and compare their conceptual frameworks, definitions employed, and structure. Both generic and condition-specific measures were reviewed. Fourteen generic and 25 condition-specific QOL instruments were identified. Eleven types of definition of QOL and health-related QOL and three theories of QOL were identified. QOL was measured by a variety of domains including emotional, social and physical health, and well-being. Items commonly assessed difficulties, or intensity/frequency of feelings/symptoms, in contrast to positive aspects of life and happiness. The findings highlight the diversity that is apparent in the conceptualization of paediatric QOL and draw attention to the lack of empirical evidence for many of the fundamental assumptions. The impact of the conceptual underpinnings of the instruments on the resulting QOL scores is discussed.